Wow, a care provider’s newsletter! At some point I have talked to each of you, and so let me start by thanking you for taking a chance and letting me have your E-Mail address. Please notice that when you receive this newsletter, I will get a return receipt so that I can quickly assess if there are any emails not getting the newsletter, in which case I will call you on the phone. There are so many email filters, some of you may have to make an adjustment to get the newsletter and to see the graphics. If all you see is text, there is an adjustment you will need to do.
A short introduction is in order. I actually know many of you from my days at NBRC. Back in 1988 I was doing the very honorable job of serving people having a developmental disability as a CPC, and from 1990 to 1994, I was working in the Quality Assurance unit for residential services. I was responsible for the Title 17 training, program design reviews, facility investigations, and facility evaluations. This experience got me interested in residential services, and my wife, Deborah McGrew, Psy.D, and I opened Christopher House, (service level 4D ARF) in 1994, and Matthew House, (Service Level 4i GH) shortly after that. I was previously an instructor for the seventy hour DSP certification class through ROP, and have three classes approved through Community Care Licensing for Continuing Education hours.
I have a lot of respect for NBRC’s responsibilities as an agency, and I have a profound and deep respect for anyone serving as a care provider. As a team, our purpose is to provide people having a developmental disability the best life they can possible have, and that involves a lot.
What to Expect
This newsletter will arrive in your email about one time per month, and will discuss things relevant to our business. There is no further obligation. Over time, I expect the newsletter will develop into a reflection of the Administrators receiving it; i.e., you may begin to become the primary contributors. The opportunity for us to communicate with each other on a large scale has endless potential. As providers, we get isolated in our own homes. It is easy for us to forget how many of us there actually are. For this first issue, about eighty homes are represented, and I expect that number to climb each month. If we all went to the same office each day, imagine the information we would be sharing. This newsletter may be the proverbial office water cooler.
More specifically, monthly topics will include important links, Title 17 information, topics from my training material, and other things I can get my hands on. I would also like to see a question / answer section. Maybe a new provider needs liability insurance, has a question about a recent evaluation, or wants to know how another provider does a certain something. The opportunity to ask a question to 100 other providers and learn what they know is valuable. I can post the question, and later the answers that come back to me via email.
Other things might include Continuing Education opportunities, staff training, and perhaps posting potential staff people looking for hours that have been cleared, have physical and TB, and First Aid.
In a word, anything sent to me can get out to as many homes as we have in our data base. That is a substantial improvement over the level of communication we have currently.
As a special note, it is important to understand that what gets posted it this newsletter are only the opinions and ideas of myself and other providers. Title 17 and 22 are the actual authorities on what we must follow. If CCL or NBRC ever disagreed with something posted in this newsletter, their opinion would obviously trump my opinion.
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Sometimes, something new comes along that is a real gift to our field. I remember my first time reading through the DSP training manuals and thinking how good and useful the material will be as a staff training manual. When I was teaching the classes, it was easy to get the students excited because they recognized the material as relevant to what they did on a daily basis. Surprisingly, the state did not mail out training manuals to each facility. You could only get the manual if you took the class, not the challenge test. But that has changed, and now if you follow the above link you can download the DSP year one and year two manuals, the most current editions. All of my in home training is based on this material. From day one that I hire someone, I start them off with this training material, and it gets documented toward meeting my Title 17 training requirements. And, by the time they do take the class or challenge test, they are one step ahead of the pack. Basically, a group of very wise people sat down and said, let’s try to identify and document the most important skills a person needs to work in this field, then develop training material to teach them these skills. How great is that! Next time someone asks what it means to be a care provider, give them those two manuals to read! |
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I have to say, I have never thought serving as an administrator was a paperwork intensive job. That might surprise some people. Sure there is paperwork, but not as bad as most would think. I like systems, checklists, and forms. All of my relevant dates for physicals and dentals are taped right on my desk where I can see it each day. I have a folder for my CLIENT NOTES requirement (Title 17 Section 56026). There is a separate tab for each resident, and within each resident’s section there are sub-sections for OVERNIGHT VISITS, ILLNESS, SIR’s, MEDICAL AND DENTAL VISITS. Remember each entry has to be signed and dated. |
Our Most Valuable Resource
I talked a little last month about how naive I was in my early years as a new care home administrator. In looking back, I do not think there is any area I underestimated more than the complexities of staffing. I have come to learn, often the hard way, that they are my most valuable resource. I recently posted a proposed Christmas schedule that changed staffing in my home for three weeks. The next day after posting the schedule, I came in and saw that my staff had agreed to every shift change, and I had several letting me know if there was anything else I needed it would be OK. This started me thinking of the many staff I have hired over the years, well over three hundred, some with me for many years, while others for only for a few days.
How do you hire a good staff person, and what does it mean to be considered a good staff person? I cannot claim any great skills when it comes to the process of hiring the best person for the job, and it is not for lack of trying. Starting with an ad in the paper, I might get forty responses, all voice mail. Through the voice mails I can rule out maybe half. I contact the last twenty by phone and from this I can rule out another ten. With the final ten, I set up the interview and given the ones that actually make it to the interview, I now have five. With these five I complete a very specific interview process, place a high emphasis on checking references, and following this, I will typically have two people out of the original forty. With these two I will set up a time for them to visit the house when the residents are home, and do an observational evaluation. At this point, I am usually prepared to offer some hours or start the process over.
Once the person is hired is where the real fun begins, because in some case it seems like I never met the person before in my life. There are certain patterns that let me know I immediately made a mistake. Late for their first shift is the biggest red flag. Immediate family emergencies, (how many people can die in a week), extensive use of their cell phone, immediate requests for advances on their checks, etc. You all know the drill.
So when that rare person comes through that fits the bill, they are truly an invaluable resource to me. Just starting with what they had to do to even work their first shift. Finger print clearance, physical and TB, and First Aid training.
Anyone trying to understand a care home, must first realize that having quality employees are the tools an owner uses to meet their goals and responsibilities. As an owner, when we leave our home for any reason, we are entrusting everything our business is to these paid employees, and as owners we will have ultimate responsibility for every action of these employees. Employees that work successfully in a care home are amazing people. The unique situations they are involved with on a daily basis require important personal attributes that the average person does not have. Direct care staff almost universally must be the type of person that can help another person to complete a bowel movement, which alone separates them from the pack of the average person.
When I have a staff person that has been well trained, and is so personally committed to their job that I can leave my facility with the confidence that they will perform as my eyes and ears while I am not there, then I have hit the jack pot. I would include in my description of a valuable staff person that they are competent in all areas of the DSP training. This material is an invaluable resource for measuring employee skills.
So what do we have? A person that has stood out from forty applicants, did not turn into a completely different person after you hired them, have finger print clearance, health clearance, first aid, you trust them in your home when you are not there, they do what they are hired to do, your residents are happy when they come on shift, they make sure the house stays clean and your residents have perfect hygiene, they are a good cook, they take the 35 hour year one DSP training and are competent in all areas of the training, they take the 35 hour year two DSP training and are competent in all areas of the training, and finally, when you want to be home with your family on Christmas, they volunteer to work an extra shift for you.
Is there any doubt what our most valuable resource is?
Record Keeping:
What a big subject, and yet I can summarize the whole thing in two words: Be Organized. There is nothing more frustrating to an evaluator that to have to dig through disorganized files. I discussed this a little in October but will now go into more detail. Title 17 and 22 have a specific outline of what must be in your files. In some cases, they will overlap. You have three primary files: Residents, Personnel, and Facility. If I was setting up files for a new home, using a resident’s file as an example, I would go through Title 17 and 22 and write down each file section requirement. I would then make a tab divider in the file for each file section requirement, and from there it is a simple matter of going to each section and providing the required information; using the appropriate licensing and regional center forms.
There are many computer software programs that let you type and print the little tabs that go into the dividers, making them look very professional.
Use the type of files that you can insert a cover page into the front cover, and make a nice professional looking cover page. I have had to dig through files in over 100 homes and can tell you nothing puts an evaluator more at ease than an organized file. Your file can tell the evaluator through your tabs that you understand exactly what you are required to have, and are not haphazardly and just by luck finding things here and there.
And weed your files out. Have a safe backup storage area that holds the older information that you will likely not need.
Que and Answers Application of Positive Behavioral Support When you look at the progression of services for adults having a developmental disability, there are definite milestones where something significant has happened. The de-emphasis of state institutions and development of community based programs, the increasing awareness that people having a developmental disability can continue to learn and grow, and the Lanterman Act, to name a few. There has also been the introduction of more positive methodologies in working with people having developmental disabilities, such as person centered services and positive behavior support. I think it is important that collectively we are grounded in both of these areas, so this month I want to talk a little about what it means when we talk about Positive Behavioral Support. We learned in our DSP classes to view unwanted behaviors as communication. The trick, or talent, is trying to figure out what is being communicated, which in my experience is often very reasonable. But for this article, we want to begin even before the unwanted behavior occurs. In order to understand what is going to influence unwanted behaviors in our residents, let’s start with where those behaviors come from in ourselves. For this, I like to use the example of a staying at a luxury hotel. Economy Hotels are fine, but every now and then, perhaps you want to splurge. You have been working hard, saved a few dollars, and have decided to spend three days and two nights at a five star hotel at the cost of $350.00 per nights. Ouch. You are in the best mood ever pulling into the hotel, and are surprised when you find no one to park your car and get your bags. Oh well, no problem. You get into the hotel, finally, and find the desk clerk busy talking on her cell phone, looking your direction infrequently as if annoyed that you are interrupting her phone call. You feel as though your precious time in your luxury room is slipping away like sand through an hourglass. Oh well, stay happy, don’t let anything ruin your trip. Finally, you get to your room, and are surprised to discover it is actually very normal, not much different than any other place you have stayed . . . and what is that smell. Your vacation happiness is slowly slipping away. You don’t want to be upset, you are doing everything you can to be in a good mood, but it is not working. The room is small, stuffy, smelly, and you think dirty. No way are you going to pay $350.00 a night for this! With a call down to the lobby you learn no rooms are available, your money is not refundable, and by the way, the pool and sauna are closed for construction. You are now enraged. You ask for the manager only to learn you are talking to the manager. You decide to go down to the lobby, and before you realize it, you are having a level 4i fit in front of everyone. After ten minutes of letting them know what you think, and all the things you are going to do to hurt their business, you leave to go back to your room, kicking the lobby couch as you exit the lobby. One desk clerk turns to the others and says, “Man that guy is one of the worse customers we have every had!” What! You are not a bad customer, it was the environment that caused your behaviors. And in the context of your expectations, your behaviors were rational, and some or more of us would have behaved the same. Not to understand the behaviors in the context of what was trying to be communicated, you can appear as a madman. To describe the resident in terms of their behaviors, and ignore what the behaviors are trying to communicate, is a fruitless endeavor. So the first step in the development of a Positive Behavior Support Plan, focuses on all the things we can do prior to even meeting the resident. If the hotel had fixed all of those problems before you checked into the hotel, the unwanted behaviors would have been a non issue. So that is where we start. How much can we have in place before the consumer moves in, that will contribute to removing potential unwanted behaviors? I will pick this up in March. As an activity, see how many things you can identify, that you can do in the intake process, that will contribute to a positive behavior support plan. Application of Positive Behavioral Support Part Two Well, I hope everyone enjoyed their stay at the luxury hotel last month. I think it is easy to see that without understanding the context of why those behaviors were occurring, they would appear irrational. If we are able to understand the context, and what is being communicated, then the behaviors are more rational. In fact, many of us would respond the same in a similar situation. This is the challenge in working with unwanted behaviors in our consumers. One, how much can we do to prevent the behavior before it occurs; and two, how well can we understand what the behavior is trying to communicate after it has occurred? The difference between a resident being evaluated as needing service level 3 or level 4I services for their unwanted behaviors, can often be our failure more than the resident’s. Pretty bold statement, but let’s break it down, starting with how much we can do before the resident even moves into our home. The intake process is where everything begins, and is the cornerstone of getting off on the right foot. Title 17 and Title 22 dictates the type of information we are required to have prior to accepting a resident. IPP, physical & TB, likes & dislikes, history of aggression, pre-placement appraisal information, needs and service plan, functional capabilities assessment, Psych/Social/Health history, etc. All, very important information. The question is, how well do we know the individual at the end of this process? Consider this exercise, one that I like to do in some of my classes. Role play that you are moving into a care home, and the administrator of the home has given you 24 hours to write down everything you consider to be important about your services in this new home. However, after twenty-four hours, you cannot add anything new to your list. I would suspect, more that a list, you would write an actual book. My guess is we would all be writing nonstop, constantly remembering at least one more thing before we turned in the book. I can see chapters on Food, Social, Recreation, Activities, TV, Music, Personal Routines, Things That Cannot Be Compromised, Staff Interactions, Personal Hygiene, Privacy, etc., etc., etc. How about the type of bed you sleep in, number of blankets, window open or closed, length of shower, shower in morning or evening, cereal or oatmeal, coffee or tea, etc., etc., etc. The intake process can be tapped to acquire this level of information. You may even developed your own form to document this type of information. It is during the intake process that you will have the greatest attention from the social worker, family, friends, circle of support, and even day program. Consider the increased confidence you will get from the CPC and family when your focus is on everything the individual needs to be happy in their new home. So you have accepted as a new resident, Johnny, a person more frequently described by his unwanted behaviors than by anything else. You have learned through your comprehensive intake procedure that Johnny likes to take a shower not bath, favorite soap is Ivory, favorite shampoo is Herbal Essence, takes at least 15 minutes for each shower, loves Frosted Flakes and English Muffins for breakfast, likes coffee with cream and sugar, and does not want to be rushed when getting ready for program. Let’s say on Johnny’s first morning in your home you have everyone of those things in place, including staff training for each of these areas. I would suspect Johnny is going to be a happy camper, and many of those behaviors other homes were complaining about, will not even surface. Sometimes one behavior is not compatible with another behavior. Try being mad when you are eating ice cream. Now picture the opposite. None of those things are in place on Johnny’s first day. In this case, the likelihood of unwanted behaviors surfacing becomes more possible, just like in our luxury hotel. In April, I would like to continue with this, looking at unwanted behaviors that occur regardless of our best efforts, and how we deal with them without deviating from our positive behavioral approach. I truly believe, and have proved over and over, that a strong person centered, positive behavioral approach, will dramatically reduce unwanted behaviors. Yes, we are doing this for the resident, but the benefit to our home’s ability to keep staff, avoid costly repairs, and manage worker’s compensation is immense. I think we call that a win-. Application of Positive Behavioral Support Part Three In Part One, we looked at unwanted behaviors that first appear to be irrational. With closer examination and understanding, we saw that these behaviors made perfect sense. To some extent, such behaviors could have been anticipated. In part two, we looked at the value of knowing the consumer as an individual. We talked about many things we can do to prevent unwanted behaviors before this person even moves in to our home. In part three, we are going to look at unwanted behaviors that occur after the person has moved into the home, perhaps even years after. When unwanted behaviors first appear, the tendency is to immediately focus on the resident. Many of our behavior plans will involve something that happens to the resident, such as positive reinforcement, token economy, or maybe even a medication adjustment. But what should first concern us, is do we know what we are treating? If I start a behavior plan on the person that was unhappy with their luxury hotel room, am I really doing anything to fix the problem? No. In order to fix the problem, I have to understand what the behavior, (tantrum in the hotel lobby), was trying to communicate. If I can understand what the unwanted behavior is trying to communicate, then I can take steps to correct the problem. Typically, using this approach, your focus is not going to be trying to affect change in the consumer, but in the consumer’s environment. Like the good family therapist, we shift our focus from the identified patient, (my child is bad), to take a systemic approach, and analyze the bigger picture. Only in the context of this bigger picture, can the unwanted behavior be understood. Understanding what the behavior is trying to communicate is the first step in this process. This may be very complex and require a lot of detective work on your part. Lets’ start with the question: “What is the quality of life this person is achieving in our home, and what can we do to make it better?” It is a fact that you cannot be happy when sad, bored when interested, comfortable when uncomfortable, etc. So we will start by looking at all of the factors. Immediate concerns include staff relationships, how comfortable are personal accommodations, opportunities to have fun, quality of food, day program, family relationships, personal care, opportunity to make choices, level of privacy, level of personal freedom, adherence to client rights, medical problems, etc. Within each of these categories there will be many sub categories. Notice that none of our attention is on the resident’s actual behavior. We are starting with the core belief, that what the behavior is trying to communicate, is a rational request. We may not like how the request is being made, (throwing food on the floor), but we know if we address the communication and not the behavior, we have a much better chance of fixing the unwanted behavior. Using an example from my experience, if not a somewhat too easy example, I have the story of “Give Me Some Food!” This resident, usually about one hour before dinner, started to have very aggressive behaviors. It did not help that he was also big and strong. What was being communicated, I suppose, was easy enough to figure out, “I’m hungry!” The smell of the food being cooked prior to dinner being served was the antecedent to the behavior. We dealt with the problem by reminding him dinner would be ready soon. We sort of had a mental block that you don’t eat snacks right before dinner. We finally got smart and put out a bowl of popcorn during this one hour period before dinner, and it was 100% successful. What was being communicated was rational. How it was being communicated, was dangerous to staff working with him. There are so many areas of a resident’s life that have to be examined, that it really does take a detective’s patience sometimes. We may fully understand what is being communicated, but maybe we have come to the conclusion that our resident should not have that thing they want. If so, you may want to discuss it with your CPC at the regional center and see if they agree with your rationale. The main point, which I think is clear, is not to try to alter a behavior until it’s purpose is understood. A resident that smashes out your car window, may be seen as rational if it is 100 degrees outside and the air conditioner is not working. Remember to share problem behaviors in your home with the Regional Center. Regional Centers can only help if you raise your hand and ask for help. Any behavior plans you are running to prevent unwanted behaviors should be well documented and approved by your CPC. Each Regional Center has an extensive list of experts and professionals, and they all what to help you when you have a problem you cannot solve. July 2008 Risk Management – Part One When you think about it, we apply Risk Management techniques on a daily basis. Following the laws of the road, buying insurance, paying into a retirement fund, etc. Through these actions, we want to head off the possibility of something bad happening to us in the future. Running a residential facility is a very high risk activity. There is so much that can go wrong, and the consequences can be dire. What happens when things go wrong in our homes? Hold your breath, not trying to shake you up, but it is a fairly long list of problems. Including: Injury or even death to a resident Investigation from the Police, APS, CPS, Community Care Licensing, Regional Center SIR, Unusual Incident, APS/CPS reports to write Relocation of one or all residents Massive workmen’s compensation increases Loss of liability insurance Loss of staff Law suit(s) Loss of reputation Loss of future referrals, and more I’m sure. Sorry about that, but as I mentioned, running a residential facility is a high risk activity. We have a lot on the line. I truly miss the days of working under a corporate umbrella where not one thing listed above was something I had to proactively protect myself against. If we, as administrators, had complete control over everything that happened in our homes, the risk factor may go down. But once you hire a single staff person, some of that control seeps away. The more staff, the less control we have, and the higher the risk for each hour, day, and week of providing services. So, how do we proactively protect ourselves, and in affect decrease the risk of running a residential facility? I think there are tons of things we can do. If we evaluate the risk with both eyes open, which in turns generates fear and anxiety, this should serve as motivation to do everything we can to lower our risk when running our homes. Based on that, Risk Management is an activity. Just like Title 22 and 17 take required actions to maintain compliance, so does risk management. As we go through some of this material, think about how each item can translate into an action, such as a check off form, staff training, resident services, etc. Ok, here we go. 1. Be an expert in your field. We wear a lot of hats in this field, and all of them require expertise. There is Title 17, Title 22, DSP Training, Labor Law, managing staff, working with the Regional Center and Community Care Licensing, and providing quality service to the residents in our homes. You should know Title 17, Title 22, and the Labor Law as well as anyone coming into your home. 2. Use the DSP training material. The DSP training manual is brilliant in scope and relevance to our field. From the first day a new staff is hired they should have their nose in that book. The state gave us a real gift when they developed the DSP manuals. 3. Smart choices when choosing new residents, and comprehensive intake procedures. Man we can really get into trouble here. This was discussed in detail in an May’s Newsletter. Let’s face it, we can get desperate for a placement and our judgment can fail us. I have made horrendous mistakes. Your intake procedure can go way past what is required by Title 17 and Title 22. Develop your own intake procedure and consider thinking outside of the box. Be especially careful with emergency placements where things can move very quickly. 4. Recognize your team. We are not alone. You have a highly developed team of professionals at your beck and call, aka the Regional Center and Community Care Licensing. They know your challenges. The worst thing you can do is hold onto a problem without pulling in your team. Regional Centers have an extensive list of professionals all available to help you with your problem. Use them. The faster you communicate your problem using the phone, SIR, or unusual incident report, the lower your risk becomes. The longer you hold onto your problem, the bigger the risk becomes. 5. You have the right to bail. If you are in over your head with a specific resident, you know it is just a matter of time before something bad happens. Contact Community Care Licensing and the Regional Center, and let them know. Once you’ve made this two minute phone call, you have taken an enormous step toward protecting your home. 6. New Staff. Your hiring practices are critically tied to your Risk Management plan of action. How extensive and detailed can you get in your hiring practices? How much initial training can you do in the beginning as a counterattack toward potential risk? Be interested in how they were trained in their last care home position. Ask specific questions, because any bad habits learned will now be in your home. 7. Protect Me? Change your view of Title 17, Title 22, Licensing Visits, and Regional Center Visits. Instead of seeing regulations as something to be in compliance with, view them as ways to protect your home and to lower your risk factor. When professionals come out to evaluate your home, welcome the opportunity because every problem they discover will lower your risk factor. Well, I don’t know about you but I’m tired. I will stop here and follow up with Part Two in the next newsletter. Tips to Prevent Heat Related Illness Special Thanks to Nancy Spiegel, Harbor Regional Center Following are some tips to prevent heat-related illness: Heat Stroke and Heat Exhaustion Warning signs of heat stroke vary, but may include: Warning signs of heat exhaustion vary, but may include: What to Do If a victim’s muscles twitch uncontrollably as a result of heat stroke, keep the victim from injuring him/herself, but do not place any object in the mouth and do not give fluids. If there is vomiting, make sure the airway remains open by turning the victim on his/her side. Quality of Life Imagine for a second you are moving into a new care home. The administrator asks you to write down everything they should know for you to be happy in their home. They go on to say that you have only twenty-four hours to write this information, and after that no more information can be added. My guess is that you will be writing nonstop for twenty four hours, and instead of an intake form you will turn in a book. Residential services can be as individual in their delivery of services as any supported living arrangement. Why not? It is only a matter of providing services that are unique to the individual living there. In your “book” that you are writing for the above home, you are going to discuss food, entertainment, how staff treat and talk to you, routines that are important to you, religion, holidays, health care, personal care, choice, things that cannot be compromised no matter what, and more. It is reasonable to assume that the closer the home comes to meeting your expectation, the higher quality of life you are going to have in that home. It is as simple or complex as that. Trying to discover everything a person needs to be happy in your home may require a lot of detective work, or may be as simple as asking. Taking what you have learned and making it the priority in the delivery of services is straight forward. Realizing that in doing this you are equally practicing proactive risk management might be the icing on the cake. Appreciate that for every new staff that is hired, the resident may, to some extent, feel like they are moving into a new home and starting over; unless we have something in place that can get that new staff person quickly up to speed. Special note: When the consumer, social worker, and family members all see that the things discussed above are some of your most important concerns during the intake process, they are going to feel very confident about their residential choice. Staff Training How can we consistently anticipate the training each administrator and support staff will need to be successful? I’m not sure we can, but we can cover as many bases as possible. Training is fine, but every time one person leaves and a new one is hired, the cycle of “not knowing” starts over again. Consider adding training documents to your personnel file that have to be read and signed by each new staff person. For example how about: Guidelines For Appropriate Staff Behavior Personal Care Protocol Kitchen Protocol Medication Distribution Protocol Management of Difficult Behaviors Protocol Privacy Protocol Refrigerator Protocol This additional training built on top of the Title 17 orientation training provides further protection against something happening because the new person, “did not know”, which is the place where bad things happen. If something bad does happen, we can show how we were proactive in trying to prevent it from happening. At that point it becomes more of a staff being out of compliance than something we never taught them in the first place. It is being proactive. Red Flags There are periods of time, while running a residential facility, when things run so well that our guard goes down. We have to stay focused to the point that we always recognize the red flags when they appear. Some red flag moments would include: New Medication (Prescription) New Medication (OTC) Any PRN Medication New Resident New Unwanted Behavior Any Health Care Problem New Staff Feeling like things are running well. :} Documentation There are many types of documentation. For me, documentation means insuring everyone is on board with everything going on in your home. Unusual Incident Reports, Regional Center SIR’s, Immediate Danger, Quarterly and Semi Annual Reports, ID Team Meetings, documented phone calls, and even letters, can all serve to protect your home. This goes back to “pulling in your team” when you have a problem or need help. If we do not get the documentation rolling, the only person holding the ball is us, and that is not a good place to be. Again, even if something goes very wrong, the more you can document efforts to fix the problem, the better off you will be. Conclusion I would say most of this comes from the school of hard knocks. I have been repeatedly humbled by how challenging this field is, and how venerable we are to things that can go wrong. I’m going to stop here, but welcome contributions of things some of you have done to protect your home and your residents, and include them in the next newsletter. November 2008 Can’t say it was hard to come up with a topic for the newsletter this month. What is up with this economy? I guess the answer is nothing! I don’t want to be yet another one screaming, “the sky is falling”, but I certainly have a few bumps on my head from something. Our biggest investment when entering this field is our home. It is the single biggest barrier that prevents people from opening a care home. For many of us, this investment doubles as our retirement plan. If that is the case for you, your retirement has taken a major setback. Given the purchase of a home, the importance of getting referrals and keeping consumers happy in your home are of critical importance. I’m going to fall back on something I wrote several years ago specific to new providers coming into the system, but I think it is equally applicable to existing homes. One thing that is hard to appreciate for people outside of our business, is the affect of not having enough consumers living in our home to support the expenses. Although staffing ratios decrease when there are fewer residents, many things such as the mortgage, utilities, and insurance do not. With the economy tanking the way it is, one thing we can least afford is for our home to be empty or to have lots of vacancies. This is true for any day program, supported living program, supported employment program, etc. The process of opening a care home can be long and expensive. The excitement of being able to accept residents after this long and expensive process is rewarding. You’ve made it! You are a Care Provider! Well, sort of. That is to say if you actually had someone to take care of you might be a care provider. There are no agencies obligated to place people in your home just because you are licensed and vendored. This can be a heartbreaking realization. You are paying major bills each month with no money coming back. In time, you will go out of business without having a single referral to your home. Go ahead and scream. When I was a social worker, I was responsible for approving new homes and brining them into our system. Although the above concern was discussed at length, it is hard to deter a person that is sure they want to become a new provider. Usually within the first month or so of the new home being vendored, the expected phone call would come in from the now crestfallen and somewhat scared provider, calling to see if we had any residents interested in their home. Depending on the type of home you want to open, or currently have open, you may be just another pea in the pot. The final decision of where a consumer will live will be made first by the consumer, maybe the social worker, and maybe even still a family member. You as the provider will have no involvement, other than to accept or not to accept the resident if they do choose your home. But hey, this newsletter is not about getting discouraged and distraught. It is about getting our eyes open and anticipating the realities of this business. So what is the solution to the problem? Do not be a pea in the pot. Instead, be a piece of corn. Ok, too much with the veggies, but you get the idea. You have to specialize, and like the proverbial farmer, be outstanding in your field. You have to know the current needs of the agency you are serving, and adjust your program design accordingly. You have to be noticed. All social workers that will be making placement decisions in your home must know you exist and have a reason to think about you over the other twenty homes that also have vacancies. How are you going to do this? You want to consult your placement agency and get permission for any ideas, but I would want every social worker to have a professional brochure to inform them about my home. Given permission, I would have an open house, and take every opportunity to invite social workers to see my home. Do what you have to do. Go to Board Meetings and Vendor Advisory Committee meetings. Every time they do introductions you will be able to stand up and say the name of your home. Have an identity that stands out because you provide specialized services. Service needs for a regional center change from year to year. You have to have your finger on their pulse so you can anticipate their needs and adjust accordingly. At the very least, be on the mailing list for any “Request For Programs” that are mailed out. But above all, have something that makes your services stand out above others. Yes, ultimately it will be up to the consumer, but you first need a social worker to inform the consumer your home even exists. Finally, protect your reputation. A good reputation will carry you, and a bad reputation will break you. Special Note: Feel free to contribute any ideas you may have specific to this topic, or ways you’ve discovered to save resources during this very unstable economy. The first page shows each resident, their last physical, TB, and dental. It is very informal and I just cross out the last one and write in the new one as they occur. If I see one is due in 30 to 60 days it goes on my to-do list and does not come off until completed. The next page lists each staff member, then a box in front of their name for each month of the year. In the box goes the amount of training they completed each month, giving me a very quick reference. Next Page, again with the staff, again with a box for each item, list the date of their First Aid and the date it expires, date they must have their DSP One, and date they must have their DSP Two, based on hired dates. Next, review of the Staff Schedule to insure compliance with Title 17 staffing requirements. Misunderstanding of this requirement, and how to accurately count hours, can cost thousands if you are over staffed, and result in a decreased level if you are understaffed. Good to be compulsive on this one. Water temperature. Basically take it and document the date and the temperature. This may be helpful to show licensing when they are in your home. They will appreciate that you take this requirement seriously. (105 – 120F) Review all food storage procedures keeping an eye on leftovers being dated, fresh fruit, throw out expired food, freezer: 0, Refrigerator: 45, Menus. Clean and organize medication box / cabinet. Insure centralized medication documentation is current. Do not keep OTC medication not being used. Fire Drill dates. You might be able to add to this list. The idea is to stay on top of those things that expire over time. It is convenient and in my experience really helps. Challenges in Residential Services: Staff Training One value I have tried to instill in my staff is that a care home does not have to be restrictive. In my mind, there are no reasons that residential cannot achieve the same characteristics of Supported Living. The point is not what it is called, but what is offered and how it is offered. That might surprise some people that have a more restrictive view of residential, but why would it have to be? If an environment is restrictive it is because of the people within that environment. Restrictiveness can occur in a child’s home with over controlling parents, or supported living with an over controlling staff. Staff is what determines the overall characteristics of a residential environment. Take for example a wealthy person that is getting on in years and wants to hire someone to help her do some of the things she can no longer do for herself. Let’s say she hires me at $50.00 per hour to come in twenty hours a week. My job, in its most simplistic form, is to help her do those things she can no longer do for herself. Providing services in residential is, I think, just that basic. I cannot yell at my new boss, I am not her boss because she needs support services, and her home does not become my home. I am only there to help with those things she is unable to do for herself. Because I am in her home twenty hours a weeks, she is going to expect to feel comfortable with me, trust me, and even like me. One problem we run into is that staff does have a sense of their huge responsibility, and it can unnerve them a little bit. Sometimes the skills used at home to raise their own children, accidentally pokes out in the adult residential environment. In this there may be a tendency to be over controlling, unless adequate training is provided. I think this is a complex subject, and certainly is not universally true, but from my experiences, it takes a lot of effort to train a new staff person to reflect the relationship described above. When this level of training is not provided, I think it will likely result in a more restrictive environment; e.g., use of bedtimes. I discuss this because I think in residential we might have an image problem. In my experiences, residential is typically looked at as more restrictive than supported living. There may be a sense that because a person has been hired to work in this home and is paid to assist other people, that on some level they become the authority, or even the boss. A DSP starting at entry level, maybe even their first job, may never have been in a position of authority and now all of a sudden is. Where typically getting to a position of authority may take years of training and experience, here it happens on the first day of employment. In a supported living environment, this is going to be a glaring problem and the people that have developed supported living at the grass roots level, (including myself in the CSLA days), are going to intervene and retrain the staff and show them the error of their way. Achieving the characteristics of the wealthy individual above is going to be their primary focus in training the supported living staff. This is a training challenge. At what point have we reached an inappropriate level of control in our homes? This is important because we want those people that place residents in our homes or evaluate our homes to never believe care homes are too restrictive or over controlling. Because if they do, than we become a less viable resource when placements are being considered. Ideally, our home would be considered as meaningful of a placement as a supported living placement. In the context of talking about a training need, it has to be noted that DSPs providing residential services are some of the highest trained DSPs out there. The qualifications to work as a DSP in residential are black and white. Clear criminal history, current First Aid, Physical and TB clearance, Orientation Training, Continuing Education Training, and a thirty-five hour DSP class and competency test in the first year; and a thirty-five hour DSP class and competency test in the second year. (Not forgetting the opportunity to take a challenge test and avoid the DSP class altogether.) To further understand the responsibilities of a DSP in residential all you have to do is read the DSP One and DSP Two manual. By anyone’s standards this is a specifically defined job with high expectations, that when not done successfully can have dire consequences. For me, this is where the complexities of this field really can be found. How much can we train and mold a person into what we need for them to be successful in a care home, or to reflect in their day to day activities the example above with the wealthy person that has hired us to assist with some things they are unable to do for themselves? The bottom line is the DSP will always be the primary factor that will define the quality of services in the home. Starting with how the residents are treated , the level of fun offered, the quality of food served, outings in the community, comprehensive health care, and day to day life are all based on our performance as Direct Support Professionals. Here is something I found in The College of Direct Support Newsletter: DSPs are America’s quiet and unknown heroes. Their dedicated and hard work improves the lives of those they support. Many DSPs work more than one job. They are devoted to the profession – and to those they serve. In conclusion to what is starting to sound a little convoluted, I would say the characteristics and personality of the DSP, (in all environments not just residential), will always have the ability to trump the DSP training, and in that is the challenge. The training needs becomes more defined by the individual and not the field. That is the complexity I have been trying to put my finger on. I’m not sure anything is being answered here as much as I am just thinking out loud. I always appreciate comments and contributions that can be included in the next Newsletter. Challenges in Residential Services: Staff Funding Understanding staffing in residential services means beginning with the model defined by the State of California. They determine the funding, qualifications, staffing level, and very comprehensive training material for how they expect services to be provided; i.e., Title 17, Title 22, DSP ONE, and DSP TWO. The only item above that is not well defined is funding. Homes can vary a lot in what DSP’s are paid. I would be interested to know the State’s average pay for a DSP. No, I’m not going to turn this into a give us more money piece. Everyone is hurting right now and more cuts are on the horizon. However any discussion of staffing in residential can be grounded or at least started with knowing the average pay for this field. Understanding the funding is a part of understanding personal expectations. And it is difficult because funding can vary dramatically based on property cost, workmen’s compensation cost, liability cost, etc. A home located downtown San Francisco is going to face many more financial challenges than a home located in Oakland. A home with a 200% per-cent workman’s compensation modifier is going to be financially weaker than a home at 97%. [If anyone has links on this type of information please get them to me. I did some research and much of the data I found is old or hard to identify where it is coming from; i.e., average pay for DSP’s working in residential under DDS.] I do think there are things we can do to support our staff that are not always monetarily based. Those of you that remember the December 2007 Care Provider Connections’ article, “Our Most Valuable Resource”, know I hold DSPs in high esteem. Given a diminishing ability to provide monetary appreciation for their hard work, over the years I have developed other ways of showing appreciation. I hope these do not make me sound like I’m competing for boss of the year. These all have been hard lessons learned for me. I did not walk into the field doing these things; I just came to value them over time. I also know that these ideas are second nature for all of you. More so, I want to see if we can add to the list. 1. Maintaining a high level of respect for how I interact with staff, even when there are problem areas. My approach with staff is to preface every criticism with mentioning that I want them to continue to get higher and higher paying jobs throughout their career, and that here are some things that might help. 2. I tend not to see staff as what they are, but what they can become. I won’t throw the baby out with the bath water. 3. If a staff person is upset about anything related to their job, it is my number one priority to fix it. 4. Flexibility in the staffing schedule that, as best I am able, accommodates their family or second job. 5. If outings are fun for the staff they will likely be fun for the residents. 6. The smallest things can develop long term dedication from staff. For example, giving a staff person a little extra pay the day before their vacation and telling them it is from the care home. Saying thank you when handing out the pay checks, before they say thank you. Approaching a staff person having a hard time for whatever reason and telling them they can take the day off with pay. Some of these things you can’t always do, but sometimes you can. Telling a staff person, (when it is true), “you are a great staff person and the residents are lucky you work here. Bringing in special treats and letting them know it is for them as much as for the residents, and being responsive to anything they need to do their job better. Also, letting a DSP get a paid lunch when they are out in the community with the residents. I know there are some other ideas out there and I would like to get them for the next newsletter; i.e., what are some creative ideas of how to take care of our DSPs in hard economic times? Title 17 Staffing requirements 8am – 9am 9am – 10pm Etc For each staff working during that hour make a mark. For example, staff #1 comes in at 8am and leaves at 10am. Staff #2 comes in at 8am and leaves at 9am. So it would look like this: 8am – 9am XX 9am – 10pm X Remember the following chart is referring to Additional staff only. In the above example there is one hour of additional staffing; i.e. Staff #2 working from 8am to 9am, and no additional staffing between 9am and 10am. Additional Direct Care Staff Hours by Service Level Number of Additional Weekly Hours for Each Additional Consumer Service Level 1* 2* 3* 4* 5* 6* 7 or more* 2 12 3 Basic 4 19 19 19 4A Staffing 12 21 21 21 4B Level 24 24 24 24 4C 9 27 27 27 27 4D 18 30 30 30 30 4E 30 34 34 34 34 4F 4 38 38 38 38 38 4G 12 42 42 42 42 42 4H 22 47 47 47 47 47 4I 36 54 54 54 54 54 *Consumer
June 2009 California Budget Crisis and Residential Services In working to implement the recent 3% cut issued by DDS, I quickly came to realize that residential is in a unique situation; i.e., where do you cut? The obvious answer was staring me in the face but I tried to ignore it. We cannot decrease staffing because it is a title 17 requirement. Our mortgage does not go down, nor do utilities, workmen’s compensation, liability insurance, food, etc. Most of the budget numbers in residential are very hard numbers; except, of course, for the administrator’s salary. I have included, as an attachment, an interesting research that studied wages for DSP’s throughout the United States, and it shows that the average starting pay for a DSP in California is $8.35, and the average pay overall is $9.48. Although we are always going to have providers that are conservative in what they pay, and others that are liberal, having a state average prevents us from saying it is because all of them are too conservative. Keep in mind the responsibilities of the DSP which you can refresh yourself with by reading DSP binder one, and DSP binder two. My point here is that the DSP’s salary cannot be on the table when looking at what to cut. In my work to resolve my budget, it kept coming back to my pay as the administrator to be the only adjustable item. What does that mean exactly? It may mean that what sounds like a 3% cut is actually a 15% to 20% cut specifically for the administrator. Given an additional proposed 7% cut, it may mean a 50% to 60% cut in pay for the administrator. Ouch! This is about the point that I started to lose sleep. Residential expenses are hard numbers that have to be examined and appreciated. The place a person lives is the last line of support services to defend. If the focus is on 3% and an additional proposed 7%, it may not sound like much. But when applied to a single line item, it can be very serious. I know from talking to regional center people that this fact is appreciated and understood, and, the additional 7% cut may be off the table but I have not been able to confirm this. I do not envy DDS and regional centers right now. I never met a regional center employee that wanted to do anything other than serve people having a developmental disability. This is an awful time to be in their shoes. I would appreciate any ideas out there that you have come up with to accommodate the 3% budget cut, and will post them the next newsletter. One thing we do for our staff is to have a birthday party for them with cake and gifts (even small gifts from clients who want to give). All of our residents love a party so it is a special treat for them also. Staff is always surprised to have a birthday party for them. I like this idea because really what it does besides supporting their staff, is it makes more parties in the home. Not to mention all the time before the party getting the residents excited about the party. Another great response and idea: Thank you very much I love your newsletter. I also share your views on DSP staff. One idea I had for staff was a Hardship Fund. In these hard economical times, and living paycheck to paycheck sometimes the funds run out before the next paycheck. The Hardship Fund would have a balance of $100.00 in it and as needed, staff could borrow funds as long as they replaced the funds back on their payday. They could borrow small denominations like $20 to $40 just to fill in that gap between paychecks. Individuals would be on the honor system, and expected to payback so funds would be available for the next hardship or other co-workers. I like this idea because no one likes to have to ask for money. But sometimes they have to. DSP Training Anyone following these newsletters knows I am a big fan of the DSP training material. I have long advocated to do your own DSP training from the first day you hire a new employee. There is no reason to wait for the next DSP class for such valuable training. The people that sat down and put this material together were brilliant. I suspect they found it a challenge to come up with a definitive document that teaches what a person needs to know when working in residential services. Prior to this, we had Title 17 and Title 22, but the DSP training material is much more pertinent to the day to day activities of residential services. The need to develop this material reflects the complexities of residential services. If memory serves me, it stems from state wide care home statistics that indicated there were big problems. Poor training in some jobs means your business is less effective or makes less money. Poor training in our business translates into medication errors, poor management of health care, inappropriate treatment plans, and increased provider risk. The first class is a thirty-five hour class. DSP Two is another thirty-five hour class. The major components of the DSP One training includes Risk Management, Incident Reporting, Medication Management, Health Care including dental, Illness and Injury, Environmental Safety, Communication, and Positive Behavior Support. (Side note: Is anyone as shocked as I am regarding the recent loss of dental care benefits? How could that happen? Really not something I ever thought could happen. If anyone has any current information about this please let me know.) When you think about each of those topics, you have to walk away with a deep respect for what we do on a daily basis. It is hard to imagine more relevant classes for our field. Notice this newsletter has a link to both of the DSP One and DSP Two manuals. It is a little daunting to print these, but to date I think you can only get the actual manual if you take the class. Administrators that did not take the class may be missing out on having this material in their homes. I would encourage you to do what you need to do to insure this material is in your home. When your staff gets to one end of the book, have them start over. The material is that important. I am surprised this training is not getting out to other vendored categories. Outside of our vendored category, mental health homes can also gain from this level of training. DSP One and Two is relevant to more than just us. Well, as you can tell, I am a fan. The Department of Developmental Services and the California Department of Education really hit a home run with DSP One and DSP Two. If you are not getting as much as you can out of this material, rethink it. Tip Of The Month: Medical Documentation There are various types of medical documentation required by Title 17 and Title 22. Let me not be the one to introduce extra paperwork, but . . . One thing I have started doing is carrying a medical notebook. It is the first thing I grab when going to a medical appointment. This is an informal notebook that I use for note taking at medical appointments. Residents are identified only by their initials, and as the appointment is progressing, I document what is being discussed. If they want a blood test I ask specifically what is being tested for and document it. If they take the BP, I ask for the numbers, etc. You get the idea. Now in time this will all get translated to the appropriated place to meet Title 17 and Title 22 requirements, but for me, I always have it at my fingertips. In addition, consider keeping a list of all medications in the same note book. Also, every time you go to a medical appointment, grab a business card and tape it on the back cover. To show off from other homes, translate this information into your quarterly or semi-annual reports. Your CPC will appreciate having such detailed information, I promise you. All submissions will be anonymous because the question is what is important. If someone needs information that cannot wait for until the next newsletter, I will forward them answers from other administrators as they come in.
Dear Care Provider Connections,
I am at my wits end with my resident. I am working so hard trying to do the right thing but he is always unhappy and now I am getting a little afraid he might hurt me. We have a wonderful home and very good staff, but no matter what I do he never seems happy.
Signed, Wit’s End
Dear Wit’s End,
It is easy to feel isolated in this business because we all work in our individual homes. If we all had the opportunity to work in the same building each day, can you imagine the networking that would happen? But even though we might feel isolated, we are not. I have gotten myself in way over my head with previous residents, and have always found the answer is asking NBRC for a meeting to brain storm the problem. NBRC has some amazedly talented people on staff. I have asked them for help at least six times and each time they were anxious to help. At any time in these meetings there may be a psychologist, MD, upper administration, and they have the ability to tele-conference with other professionals that may be helpful, such as a pharmacist. In every instance of using this service, I have been helped, and in one case, I am sure they saved my resident’s life. Ask for help. It is out there.
As a sub note, I would add something I frequently tell my staff. If they hold on to their problem, I cannot help them, and they remain 100% responsible for that problem, often at the cost of their job. We all make mistakes in this field. Once my staff call me and put the problem in my hands, they have taken the best step they can take to protect their job. Not discussing our problems is the only real mistake.
Scenario Of The Month
When I do my Continuing Education training, I like to introduce scenarios to stimulate open debates specific to client rights and other areas. I typically like to get as close to gray areas as possible. I am going to include a scenario here each month. You are encouraged to submit responses to be included in the newsletter next month, no names posted, or your own scenario. Often there is not any exact right answer, but I think more importantly is how the problem is being approached.
Results from last month’s scenario:
Going back to the first scenario with Barry, I tried to summarize what some of the concerns might be. It was pointed out by another provider the cash gift to staff creates a lot of concerns. The facility can quickly get compromised when accepting cash gifts from family. Both the regional center and licensing are likely to take exception. It can be interpreted as a bribe, and create a conflict of interest.
In November we discussed Sally:
Sally knows she must have good behavior all week at her day program to earn the right to go out to lunch with her day program class, which is the Friday activity most enjoyed by the class.
In this scenario we want to be careful not to use something everyone gets as a part of the normal program as a type of punishment, such as going out to lunch every Friday. At that point it becomes a negative behavioral tool.
In future months of CPC there will be a lot of discussion on what it means to run a positive behavioral program, but in its simplest form in means to avoid anything negative. For example, let’s say Monday night’s desert is Chocolate Cake. Resident Bobby acts up during dinner so he does not earn his cake. Well there was nothing to earn in the first place. It was a part of the dinner, and as such, taking it away would be inappropriate.
In order to set up a positive behavior plan for Bobby to get through dinner, it would have to include something up and beyond what he is already entitled to, although as we will see in time, there are many more things to try before jumping right into positive reinforcement of a behavior.
December’s Scenario:
Your resident, Marcia, has a history of saying people touch her inappropriately, pointing to certain parts of her body when she makes these claims. Today she comes home and tells you by name a staff person touched her inappropriately. You call the day program and learn the accused staff person was sick this day. To play it safe you leave a message with the CPC.
Did You Know …
There are two great ways to stay informed about our business. One, consider attending regional center board meetings from time to time. NBRC’s are held on the 1st Wednesday of every month excluding January, August, and November. Also, you may have noticed a link for the Vendors Advisory Committee. These meetings are often attended by NBRC’s Executive Director and are designed to provide open communication between NBRC and US! Active representation from residential providers at either meeting can go a long ways.
January, 2008
March 2008
Computer Help
The expense of protecting your computer keeps increasing. We have viruses to worry about, spyware, programs that hi-jack our computer, and other malicious programs that only want to ruin our day. You might be surprised to learn that many of the best programs out there to protect our computers are free for individual use. There is a web site I have been using for many years called http://download.cnet.com/windows/where these free programs can be found. AVG Antivirus and Ad-Aware for spyware, are both highly rated programs and are free. Even when not free, many of the programs on this site can be used on a trial basis before putting out the big bucks. I think you will find their library is extensive and that download.com is a good resource when trying to find the right software.
Ten Ways to Protect Yourself
It has to be appreciated by all, that working as the owner of a residential program comes with a lot of risk. Lawsuits are something we all live in fear of, and we must do everything within our power to protect our residents and homes. Here is a Top Ten list that I encourage others to add to from their experiences.
1. Know Title 17 and Title 22 as well as anyone coming into your home.
2. Have complete and organized resident, personnel, and facility files. Remember they have to meet both Title 17 and Title 22 requirements.
3. Maintain open communication with the regional center and Community Care Licensing. The sooner you share your problem, the more protected you are. Treat them as team members. All three of us share the same goal; i.e., quality services for people having a developmental disability.
4. Be an expert in Client Rights.
5. Actively train your staff to eat, sleep, and breathe your values.
6. Post your values openly in the house for all staff are constantly aware of where you stand.
7. Have a comprehensive medication procedure that reflects the DSP training.
8. Use the DSP manuals as your primary staff training manuals.
9. Make smart choices when deciding if a consumer will live in your home. A bad decision can ruin your life.
10. Make smart choices when deciding what staff person will work in your home. A bad decision can ruin your life.
Did You Know …
Title 17 56026(a) Consumer Notes
The administrator for each Service Level 2,3, or 4 facility shall be responsible for ensuring preparation and maintenance of on-going, written consumer notes which shall include:
1) Community and leisure activities;
2) Overnight visits away from the facility;
3) Illness;
4) SIRs
5) Medical and dental visits; and
The date and signature of the staff person making the entry.
Where Are My Friends ?
Depending on your previous job, operating a care home can be very isolating. When I worked at the Regional Center, I had peers to interact with daily. It can be striking how dramatically this changes once you open your care home. To counter this, you might consider participating in as many professional involvements as possible; i.e., stay connected. Attending trainings, board meetings, specialized functions, and Vendor Advisory Committee meetings are all good ways to stay connected. Always talk to other providers. Ask about their insurance, where they shop for furniture, food, good plumbers! Many of us reinvent the wheel over and over. Imagine if all of us care providers came to the same building each day to work. Can you picture the conversations and level of networking that would go on in that building? We need the opportunity to be with, and relate to, people that do what we do. Borrow what they know, and share what we know.
Consumer Placement
Accepting a new resident into your home is an exciting time. However, there is also a lot of risk associated with not having the information you need to make a good decision. As a care provider, when you think about the levels of risk associated with your various activities, accepting a new resident has to be high on the list. Fortunately, there are many things we can do to decrease risk in our homes. You do not want to discover, after the person has moved in, that you made a mistake.
Mistakes can mean harm and even death to a resident, loss of liability insurance, massive increases in workmen’s compensation insurance, law suits, neighbors hating you, investigations, SIR’s, major property damage, loss of your quality of life, and constant turnover of staff. That is a lot of very bad stuff, and does not reflect why we got into this business. Everything we can do to decrease our risk in this field is worth doing, and there is a lot we can do when we accept a new resident.
Title 17 and Title 22 are very specific to the amount and types of documentation you should have when accepting a new resident. Consider a check list in the front of the new resident’s file that insures you have everything. Things can sometimes move very quickly when accepting a new resident, especially if it is any emergency placement. Having your check list will let you know immediately if something is missing. Remember, those are the minimal referral package requirements. There is nothing to stop you from creating your own list of information you want in addition to the minimal package, or important questions you want to be sure and ask.
Desperation for a referral can cloud our judgment. Stay focused on what your skills are, what your service level is, and the type of people you can safely serve. Other activities that may reduce your risk include meeting with the previous care home’s administrator, resident’s family, and day program. Day visits and trial overnights will be helpful. All medical information must be complete and current. Current psychiatric reports are important if there is a psychiatrist. Reviewing all SIR’S / Unusual Incident Reports both from previous homes, and the day program, may be an eye opener. And finally, how do you feel when working with this resident. Do we like them, enjoy being with them?
I know many of you can add to this very brief outline. If you have some additions, please forward them to me and I will get them out in the next newsletter. Maybe next month we can talk about safeguards when hiring new staff, another high risk activity.
Heat stroke - which occurs when the body can’t control its temperature - may result in disability or death if emergency treatment is not given. Heat exhaustion occurs when the body loses a large amount of water and salt contained in sweat.
If you see any of these signs for heat stroke or heat exhaustion, you may be dealing with a life-threatening emergency and should do the following:
Risk Management – Part Two
There was a good response to the last newsletter specific to discussing Risk Management. I appreciate trainings that focus on the welfare of the support staff and administrators. Sometimes training that appears to be consumer focused such as proactive positive behavior management and person-centered services, can cross over and equally benefit the support staff and administrator. By preventing unwanted behaviors and improving the quality of life for the people living in our homes, we benefit by having a better work environment, less turn over, lower workmen’s compensation, less liability risk, fewer SIR’s, and in general a higher quality of life for ourselves. So it is on this note that I peg Quality of Life as the next part of our Risk Management discussion.
Are You a Pea in the Pot or a Piece of Corn?
Compliance Binder
February 2009
Responses to Last Newsletter
I wanted to share this response to our last newsletter:
October 2009